Cell 2 Soul: The Humane Health Care Blog

Bitter Pill

a chronicle of psychiatric harm

Bitter Pill by Rachel Aviv
The New Yorker, April 8, 2019

Link to Full Article.

This significant article chronicles the life of a young woman who was given multiple psychiatric diagnoses by some of the "best" psychiatrists in the country. She was placed on almost every imaginable psychiatric medicine that appear to have done her great harm. It's a cautionary tale that is well worth a close reading. The article is quite long and rambles a bit but much in it of teaching value. Charles Medawar covered a lot of this in his book, name, around 20 years ago!^1,2 But who paid attention?

The protagonist of “Bitter Pill” is Laura Delano, who was diagnosed with bipolar disorder shortly before she entered Harvard as a freshman in 2001. She saw psychiatrists at McLean Hospital in Belmont Massachusetts. There she was initially placed on Prozac, Provigil and Ambien.

Link to DJE's notes.

Here is a moving lecture by Laura Delano.

Annals of Over-Treatment

A friend sent me a link to Kaiser Health News' "Bill of the Month":  Toenail Treatment ~ $!500. 

As a dermatologist, it interested me; the more so because the expensive topical medication featured has at, best, a 10% chance of being effective.  A three-month course of Lamisil is ~ 40% successful; but as with all treatments for nail fungus, recurrences are common.

See KHN's Bill of the Month for background information and other category winners.

March 2018 Winner:  Ms. Anne Soloviev
for topical Kerydin

 

It's Not Cancer: Doctors Downgrade a Thyroid Tumor

“There’s a growing concern that many of the terms we use [when labeling a tumor] don’t match our understanding of the biology of cancer.” Calling lesions cancer when they are not leads to unnecessary and harmful treatment, he said.

A new study clarifies that: “it is not the presence of nuclear features but the presence of invasion that can make the difference between cancer and noncancer,” Nomenclature Revision for Encapsulated Follicular Variant of Papillary Thyroid CarcinomaA Paradigm Shift to Reduce Overtreatment of Indolent Tumors.

An April 15th NY Times article by Gina Kolata explains this paradigm shift well.

This is an important step; but there are many other tumors that likely fall into the same category. As practitioners and as patients when we receive a diagnosis of cancer, it behooves us to question the necessity of aggressive treatment for indolent tumors. Breast, prostate and a number of skin cancers quickly come to mind, but there will be many others. The study reported in JAMA Oncology hints that we have a ways to go and that we are in the infancy of this endeavor.

Beware (and Expect) Your Incidentaloma!

Dr. Jill Wruble's TedX talk: Incidentalomas: What they are and why you should be concerned?

An incidentaloma is a tumor (-oma) found by coincidence (incidentally) without clinical symptoms or suspicion. Like other types of incidental findings, it is found during the course of examination and imaging for other reasons. It is a common occurrence: up to 7% of all patients over 60 may harbor a benign growth, often of the adrenal or thyroid gland, that is detected when diagnostic imaging is used for the analysis of unrelated symptoms. With the increase of "whole-body CT scanning" as part of health screening programs, the chance of finding incidentalomas is expected to increase. 37% of patients receiving whole-body CT scans may have abnormal findings that need further evaluation. Since many incidentally found lesions may never cause disease, there is a huge risk of overdiagnosis. 

When faced with an unexpected finding on diagnostic imaging, the physician faces the challenge to prove that the lesion is indeed harmless. Often, more tests are required to determine the exact nature of an incidentaloma. (Wikipedia)

Dr. Jill Wruble is a New Haven radiologist who has a special interest in this area. Her TedX talk: Incidentalomas: What they are and why you should be concerned is a great introduction to this topic.  She will be speaking at Williams College in April of 2016 (exact date not set).